2012-12-17_HYDROLOGY - M1977300

• Permit No: M1977300
• IBM Index Class Name: HYDROLOGY
• Doc Date: 12/17/2012
• Doc Name: Groundwater Data for Third Quarter 2012- Section 1
• From: Cotter
• To: DRMS
• Permit Index Doc Type: Hydrology Report
• Email Name: TAK
• Media Type: D
• Archive: No

Company Name: Cotter Corporation
Tracking NO 3892013 61650983
Project Name: SchWartZ -
DATE: 9/19/12 SSTF: S26642
Report Mail Address:
Cotter Corporation - Canon City Mill
PO Box 1750; Canon City, CO 81215 -17
Contact Name: Frank Adamic
r: 1- 719- 275 -7413 ext. 204
Sampler Name If other than Contact
1- 303-642 -3893 mine phone
Bob Tennant 1- 719 -371- 3009 -cell
Invoice Address:
PO Box 1750
Canon City, CO 81215 - 1750
Invoice Contact: JoAnne Ary
1-719-275-7413 ext. 209
Fax: [phone] - 1669
Purchase Order f:
ELI Quote #:
__Ie - (7
Report Required For: POTW/W
OOtherOther
Number a containers Senate Type:
C
71 8ouds, Yta+
ANALYSIS REQUESTED
Noma! Turnaround (TAT)
Notify ELI prior to
RUSH sample
adtio charges submittal
p additional charges
t < . and scheduling
ReC@�t Temp
i^ O o
TABLE 2 - Footnob "2" applies
•
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Special Report Formats — ELI must be notified
prior to sample submittal for the following:
NELAC ❑ A2LA ❑ Level IV
Other
EDD/EDT ❑ Format
Custody dal
Y ;(M }
Intact v
Y/N
Signature
Y/N
Match LAB ID
Y / N
punouswnl N 1
Comments:
S&A Schedule Cods :
GWCODE:
Via
SAMPLE
IDENTIFICATION
(Name, Location,
Interval, etc)
Collection
Date
Collection
Time
i
❑
■
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•
❑
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D
J
2 Sump - 4
9/19/12
9:00
Water 6
®
❑
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3
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0
0
0
0
0
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0
0
0
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cc
6
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7
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CC
It
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10
0
0
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*
Received by: Date/Time:
Received Date/Time: f? ; z
Custody
Record
MUST be
Signed
Relinquished by: Bob Tennant Date/Time:9/19 /12 16:30
Shipped by: FedEx
Shipped by:
Rimed by: Date/Time:
Sa tel: Return to Client ❑ Lab Disposal �_�
LA�TORY USE ONLY
, Sample T ype * of fractions
Chain of Custody and Analytical Request Record
PLEASE PRINT; provide as much information as possible. Refer to corresponding notes on reverse side. Page 1 of 1